<%@ page language="java" contentType="text/html; charset=ISO-8859-1"
	pageEncoding="ISO-8859-1"%>
<%@ taglib uri="http://tiles.apache.org/tags-tiles" prefix="tiles"%>
<%@ taglib uri="http://java.sun.com/jstl/core" prefix="c"%>


<html>
<body>
<link rel="stylesheet" type="text/css" href="css/PrepskillsFont.css" />

<form action=https://prepskills.com/cgi-bin/ntformmail.pl method=post>
<input type=hidden name="recipient"
	value="info@prepskills.com, jseverino@prepskills.com, education@prepskills.com">
<input type=hidden name="redirect"
	value="https://prepskills.com/sent.html"> <input type=hidden
	name="return_link_url" value="https://prepskills.com/sent.html">
<input type=hidden name="subject" value="SAT Webinar Registration">
<input type=hidden name="required"
	value="email, StudentFN, StudentLN, Address, City, PostalCode, TypeofCard, NameonCard, CardNumber, CCExpiryMM, CCExpiryYYYY">

<table bgcolor="034016" border=0 cellpadding="0" cellspacing="0"
	align="center" width="960">
	<tr>

		<td>
		<table bgcolor="ffffff" class="askprepform" border=0 cellpadding="0"
			cellspacing="0" align="center" width="940">
			<tr>
				<td colspan="4" class="style5">
				<div align="center">PREPSKILLS<sup>&reg;</sup> U.S. ADMISSIONS
				WORKSHOP REGISTRATION</div>
				</td>
			</tr>
			<tr>
				<td bgcolor="#D9D9D9"><span class="style21">Select a
				Workshop:</span></td>
				<td colspan="3" bgcolor="#EAEAEA"><span class="style21">
				<select name="WorkshopDate" id="WorkshopDate">
					<option
						value="Sunday, September 25, 2011 - 1:00 pm to 5:00 pm - York U (Glendon Campus), 2275 Bayview Ave, Toronto, Ontario">Sunday,
					September 25, 2011 - 1:00 pm to 5:00 pm - York U (Glendon Campus),
					2275 Bayview Ave, Toronto, Ontario</option>
				</select> </span></td>
			</tr>
			<tr>
				<td bgcolor="f4f7e7"><span class="style21"> Email
				Address:<br>
				<span class="style18">REQUIRED</span></span></td>
				<td colspan="3" bgcolor="f4f7e7"><span class="style21">
				<input type="text" name="email" size="30" border="0"> <br>
				(Important: Course communication, login ID, and other relevant
				parent/student information will be sent to this email address.
				Please ensure that you check your email regularly)</span></td>
			</tr>
			<tr>
				<td colspan="4" bgcolor="#EAEAEA"><span class="style21">How
				did you learn about PREPSKILLS<sup>&reg;</sup>?</span></td>
			</tr>
			<tr>
				<td bgcolor="f4f7e7" width=243><span class="style21">Please
				Select:</span></td>
				<td bgcolor="f4f7e7" width=242><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <select
					name="Reference">
					<option value="Internet search">Internet search</option>
					<option value="School/Teacher">School/Teacher</option>
					<option value="Friend">Friend</option>
					<option value="PREPSKILLS(tm) Seminar">PREPSKILLS Seminar</option>
					<option value="Education Fair">Education Fair</option>
					<option value="Brochure/Flyer">Brochure/Flyer</option>
					<option value="PREPSKILLS(tm) Sign">PREPSKILLS Sign</option>
					<option value="Education Guide">Education Guide</option>
					<option value="Other">Other, Please Specify</option>
				</select> </FONT></span></td>
				<td bgcolor="f4f7e7" width=242><span class="style21">Specify:</span></td>
				<td bgcolor="f4f7e7" width=242><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="OtherReference" type="text" size=30> </FONT></span></td>
			</tr>
			<tr>
				<td colspan="4" bgcolor="#94ce18" class="style5">
				<div align="center">STUDENT INFORMATION</div>
				</td>
			</tr>
			<tr>
				<td bgcolor="#EAEAEA">
				<div align="center" class="style21">Student First Name</div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center" class="style21">Student Last Name</div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center" class="style21">Gender</div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center" class="style21">Current Grade</div>
				</td>
			</tr>
			<tr>
				<td bgcolor="f4f7e7">
				<div align="center" class="style21"><input type="text"
					name="StudentFN" size="30" border="0"></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center" class="style21"><input type="text"
					name="StudentLN" size="30" border="0"></div>
				</td>
				<td bgcolor="f4f7e7" align=center><span class="style21">
				<label> <input type="radio" name="Gender" id="Male"
					value="Male"> </label> Male <label> &nbsp;&nbsp;&nbsp; <input
					type="radio" name="Gender" id="Female" value="Female"> </label>
				Female </span></td>
				<td bgcolor="f4f7e7">
				<div align="center" class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <select
					name="ChildCurrentGrade">
					<option selected="selected" value=""></option>
					<option value="9">9</option>
					<option value="10">10</option>
					<option value="11">11</option>
					<option value="12">12</option>
				</select> </FONT></div>
				</td>
			</tr>
			<tr>
				<td bgcolor="#EAEAEA">
				<div align="center" class="style21">Date of Birth</div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center" class="style21">Age</div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center" class="style21">School Presently Attended</div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center" class="style21">When do you anticipate
				enrolment?&nbsp;</div>
				</td>
			</tr>
			<tr>
				<td bgcolor="f4f7e7">
				<div align="center" class="style21">
				<div align="center"><select name="DOBDD" id="DOBDD">
					<option selected="selected" value=""></option>
					<option value="01">01</option>
					<option value="02">02</option>
					<option value="03">03</option>
					<option value="4">04</option>
					<option value="5">05</option>
					<option value="6">06</option>
					<option value="7">07</option>
					<option value="8">08</option>
					<option value="9">09</option>
					<option value="10">10</option>
					<option value="11">11</option>
					<option value="12">12</option>
					<option value="13">13</option>
					<option value="14">14</option>
					<option value="15">15</option>
					<option value="16">16</option>
					<option value="17">17</option>
					<option value="18">18</option>
					<option value="19">19</option>
					<option value="20">20</option>
					<option value="21">21</option>
					<option value="22">22</option>
					<option value="23">23</option>
					<option value="24">24</option>
					<option value="25">25</option>
					<option value="26">26</option>
					<option value="27">27</option>
					<option value="28">28</option>
					<option value="29">29</option>
					<option value="30">30</option>
					<option value="31">31</option>
				</select> <select name="DOBMM" id="DOBMM">
					<option selected="selected" value=""></option>
					<option value="1">Jan</option>
					<option value="2">Feb</option>
					<option value="3">Mar</option>
					<option value="4">Apr</option>
					<option value="5">May</option>
					<option value="6">Jun</option>
					<option value="7">Jul</option>
					<option value="8">Aug</option>
					<option value="9">Sep</option>
					<option value="10">Oct</option>
					<option value="11">Nov</option>
					<option value="12">Dec</option>
				</select> <select name="DOBYYYY" id="DOBYYYY">
					<option selected="selected" value=""></option>
					<option value="1980">1980</option>
					<option value="1981">1981</option>
					<option value="1982">1982</option>
					<option value="1983">1983</option>
					<option value="1984">1984</option>
					<option value="1985">1985</option>
					<option value="1986">1986</option>
					<option value="1987">1987</option>
					<option value="1988">1988</option>
					<option value="1989">1989</option>
					<option value="1990">1990</option>
					<option value="1991">1991</option>
					<option value="1992">1992</option>
					<option value="1993">1993</option>
					<option value="1994">1994</option>
					<option value="1995">1995</option>
					<option value="1996">1996</option>
					<option value="1997">1997</option>
					<option value="1998">1998</option>
					<option value="1999">1999</option>
					<option value="2000">2000</option>
					<option value="2001">2001</option>
					<option value="2002">2002</option>
					<option value="2003">2003</option>
					<option value="2004">2004</option>
				</select></div>
				</div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center" class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <select
					name="Age" id="Age">
					<option selected="selected" value=""></option>
					<option value="13">13</option>
					<option value="14">14</option>
					<option value="15">15</option>
					<option value="16">16</option>
					<option value="17">17</option>
					<option value="18">18</option>
					<option value="19">19</option>
					<option value="20">20</option>
					<option value="21">21</option>
					<option value="22">22</option>
					<option value="23">23</option>
					<option value="24">24</option>
					<option value="25">25</option>
					<option value="26">26</option>
					<option value="27">27</option>
					<option value="28">28</option>
					<option value="29">29</option>
					<option value="30">30</option>
				</select></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center" class="style21">
				<div align="center"><font
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="CurrentSchool" type="text" size=30> </font></div>
				</div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center" class="style21">
				<div align="center"><select name="EnrolementDateMM"
					id="EnrolementDateMM">
					<option selected="selected" value=""></option>
					<option value="1">Jan</option>
					<option value="2">Feb</option>
					<option value="3">Mar</option>
					<option value="4">Apr</option>
					<option value="5">May</option>
					<option value="6">Jun</option>
					<option value="7">Jul</option>
					<option value="8">Aug</option>
					<option value="9">Sep</option>
					<option value="10">Oct</option>
					<option value="11">Nov</option>
					<option value="12">Dec</option>
				</select> <select name="EnrolementDateYYYY" id="EnrolementDateYYYY">
					<option selected="selected" value=""></option>
					<option value="2009">2009</option>
					<option value="2010">2010</option>
					<option value="2009">2011</option>
					<option value="2010">2012</option>
					<option value="2009">2013</option>
					<option value="2010">2014</option>
					<option value="2009">2015</option>
					<option value="2010">2016</option>
					<option value="2009">2017</option>
					<option value="2010">2018</option>
					<option value="2009">2019</option>
					<option value="2010">2020</option>
				</select></div>
				</div>
				</td>
			</tr>
			<tr>
				<td colspan="2" bgcolor="#EAEAEA">
				<div align="center"><span class="style24">Has the
				student written the SAT or ACT?</span></div>
				</td>
				<td colspan="2" bgcolor="#EAEAEA">
				<div align="center"><span class="style24">If not, has
				the student written the PREPSKILLS Diagnostic or Simulation SAT?</span></div>
				</td>
			</tr>
			<tr>
				<td colspan="2" bgcolor="f4f7e7">
				<div align="center"><span class="style24"> </span></div>
				<span class="style24"><label>
				<div align="center"><select name="WrittenSATorACT"
					id="WrittenSATorACT">
					<option selected="selected" value=""></option>
					<option value="Yes">Yes</option>
					<option value="No">No</option>
				</select></div>
				</label> </span></td>
				<td colspan="2" bgcolor="f4f7e7">
				<div align="center"><span class="style24"> <select
					name="WrittenDiagnostic" id="WrittenDiagnostic">
					<option selected="selected" value=""></option>
					<option value="Yes">Yes</option>
					<option value="No">No</option>
				</select> </span></div>
				</td>
			</tr>
			<tr>
				<td colspan="4" bgcolor="#EAEAEA"><span class="style24">If
				you answered &quot;no&quot; to both questions, when does the student
				plan to write the SAT or ACT? <select name="WriteSATDateMM2"
					id="WriteSATDateMM">
					<option selected="selected" value=""></option>
					<option value="1">Jan</option>
					<option value="2">Feb</option>
					<option value="3">Mar</option>
					<option value="4">Apr</option>
					<option value="5">May</option>
					<option value="6">Jun</option>
					<option value="7">Jul</option>
					<option value="8">Aug</option>
					<option value="9">Sep</option>
					<option value="10">Oct</option>
					<option value="11">Nov</option>
					<option value="12">Dec</option>
				</select> <select name="WriteSATDateYYYY2" id="WriteSATDateYYYY2">
					<option selected="selected" value=""></option>
					<option value="2009">2009</option>
					<option value="2010">2010</option>
					<option value="2011">2011</option>
					<option value="2012">2012</option>
					<option value="2013">2013</option>
					<option value="2014">2014</option>
					<option value="2015">2015</option>
					<option value="2016">2016</option>
					<option value="2017">2017</option>
					<option value="2018">2018</option>
					<option value="2019">2019</option>
					<option value="2020">2020</option>
				</select> </span></td>
			</tr>
			<tr>
				<td colspan="4" bgcolor="f4f7e7"><span class="style24">what
				are the student's top 3 choices for American colleges? </span> <label>
				<input name="Top3Choices" type="text" id="Top3Choices" size="90">
				</label></td>
			</tr>

			<tr>
				<td colspan="4" bgcolor="#94ce18" class="style5">
				<div align="center">PARENT INFORMATION</div>
				</td>
			</tr>
			<tr>
				<td bgcolor="#EAEAEA">
				<div align="center"><span class="style21">(Mother)
				First Name</span></div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center"><span class="style21">Last Name</span></div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center"><span class="style21">Home Phone
				Number</span></div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center"><span class="style21">Email</span></div>
				</td>
			</tr>
			<tr>
				<td bgcolor="f4f7e7">
				<div align="center"><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="MotherFN" type="text" id="MotherFN" size="30" /> </FONT></span></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center"><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="MotherLN" type="text" id="MotherLN" size="30" /> </FONT></span></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center"><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="MotherHomePh" type="text" value="(xxx) xxx - xxxx" size="30"
					maxlength="20" id="MotherHomePh" /> </FONT></span></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center"><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="MotherEmail" type="text" value="name@domain.com"
					id="MotherEmail" size="30" /> </FONT></span></div>
				</td>
			</tr>
			<tr>
				<td colspan="2" bgcolor="#EAEAEA">
				<div align="center"><span class="style21">Occupation</span></div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center"><span class="style21">Business
				Phone Number</span></div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center"><span class="style21">Cell Phone
				Number</span></div>
				</td>
			</tr>
			<tr>
				<td colspan="2" bgcolor="f4f7e7">
				<div align="center"><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="MotherOccup" type="text" id="MotherOccup" size="60">
				</FONT></span></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center"><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="MotherBusinessPh" type="text" value="(xxx) xxx - xxxx"
					size="30" maxlength="20" id="MotherBusinessPh" /> </FONT></span></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center"><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="MotherCell" type="text" value="(xxx) xxx - xxxx" size="30"
					maxlength="20" id="MotherCell" /> </FONT></span></div>
				</td>
			</tr>
			<tr>
				<td bgcolor="#EAEAEA">
				<div align="center"><span class="style21">(Father)
				First Name</span></div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center"><span class="style21">Last Name</span></div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center"><span class="style21">Home Phone
				Number</span></div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center"><span class="style21">Email</span></div>
				</td>
			</tr>
			<tr>
				<td bgcolor="f4f7e7">
				<div align="center"><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="FatherFN" type="text" id="FatherFN" size="30" /> </FONT></span></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center"><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="FatherLN" type="text" id="FatherLN" size="30" /> </FONT></span></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center"><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="FatherHomePh" type="text" value="(xxx) xxx - xxxx" size="30"
					maxlength="20" id="FatherHomePh" /> </FONT></span></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center"><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="FatherEmail" type="text" value="name@domain.com"
					id="FatherEmail" size="30" /> </FONT></span></div>
				</td>
			</tr>
			<tr>
				<td colspan="2" bgcolor="#EAEAEA">
				<div align="center"><span class="style21">Occupation</span></div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center"><span class="style21">Business
				Phone Number</span></div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center"><span class="style21">Cell Phone
				Number</span></div>
				</td>
			</tr>
			<tr>
				<td colspan="2" bgcolor="f4f7e7">
				<div align="center"><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="FatherOccup" type="text" id="FatherOccup" size="60">
				</FONT></span></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center"><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="FatherBusinessPh" type="text" value="(xxx) xxx - xxxx"
					size="30" maxlength="25" id="FatherBusinessPh" /> </FONT></span></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center"><span class="style21"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="FatherCell" type="text" value="(xxx) xxx - xxxx" size="30"
					maxlength="25" id="FatherCell" /> </FONT></span></div>
				</td>
			</tr>
			<tr>
				<td colspan="4" bgcolor="#94ce18" class="style5">
				<div align="center">MAILING ADDRESS</div>
				</td>
			</tr>
			<tr>
				<td bgcolor="#EAEAEA">
				<div align="center" class="style21">Address</div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center" class="style21">City</div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center" class="style21">Province</div>
				</td>
				<td bgcolor="#EAEAEA">
				<div align="center" class="style21">Postal Code</div>
				</td>
			</tr>
			<tr>
				<td bgcolor="f4f7e7">
				<div align="center" class="style21"><font
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="Address" type="text" size="30"> </font></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center" class="style21"><font
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="City" type="text" id="City" size="30"> </font></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center" class="style21"><select name="Province">
					<option value="Ontario">Ontario</option>
					<option value="Quebec">Quebec</option>
					<option value="Newfoundland">Newfoundland</option>
					<option value="New Brunswick">New Brunswick</option>
					<option value="Nova Scotia">Nova Scotia</option>
					<option value="Prince Edward Island">Prince Edward Island</option>
					<option value="Manitoba">Manitoba</option>
					<option value="Saskatchewan">Saskatchewan</option>
					<option value="Alberta">Alberta</option>
					<option value="British Columbia">British Columbia</option>
					<option value="Northwest Territories">Northwest
					Territories</option>
					<option value="Yukon">Yukon</option>
				</select></div>
				</td>
				<td bgcolor="f4f7e7">
				<div align="center" class="style21"><font
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="PostalCode" type="text" id="PostalCode" size="8"> </font></div>
				</td>
			</tr>
			<tr>
				<td colspan="4" bgcolor="#94ce18" class="style5">
				<div align="center">ADDITIONAL INFORMATION</div>
				</td>
			</tr>
			<tr>
				<td colspan="4" bgcolor="#EAEAEA">
				<div align="center" class="style21">Comments</div>
				</td>
			</tr>
			<tr>
				<td colspan="4" bgcolor="f4f7e7">
				<div align="center"><textarea name="Comments" rows="3"
					cols="110"></textarea></div>
				</td>
			</tr>
			<tr>
				<td colspan="4" bgcolor="#94ce18" class="style5">
				<div align="center">FEES & PAYMENT INFORMATION</div>
				</td>
			</tr>
			<tr>
				<td colspan="4" bgcolor="#EAEAEA">
				<p class="style21"><strong>FEES: </strong><br>

				<strong>$495 + HST <span class="style18">(cheque,
				money order, or VISA/MASTERCARD* - call (416) 200-7728 to process
				your visa/mastercard registration if desired)</span></strong><br>
				</span>
				</td>

			</tr>
			<tr>
				<td valign="top" bgcolor="#f4f7e7" class="style21"><br>
				<strong>Cheque / Money Order</strong></td>
				<td colspan="3" bgcolor="#f4f7e7" class="style21">
				<p><span class="style21">Titled To: </span><strong><span
					class="style21">PREPSKILLS INC.</span></strong></p>
				<p><span class="style21">Mailing Address: 250 Merton
				Street, Suite 404, Toronto, Ontario, M4S 1B1</span></p>
				<p><span class="style21"><span class="style18"><strong>FULL
				PAYMENT MUST BE RECEIVED AT THE TIME OF REGISTRATION</strong></span></span></p>
				</td>

			</tr>
			<tr>
				<td colspan="4" bgcolor="#EAEAEA" class="style21"><strong>Credit
				Card Payment</strong></td>
			</tr>
			<tr>
				<td bgcolor="#f4f7e7" class="style21">
				<div align="center">Type of Card</div>
				</td>
				<td bgcolor="#f4f7e7" class="style21">
				<div align="center">Name on Card</div>
				</td>

				<td bgcolor="#f4f7e7" class="style21">
				<div align="center">Card Number</div>
				</td>
				<td bgcolor="#f4f7e7" class="style21">
				<div align="center">Expiry Date</div>
				</td>
			</tr>
			<tr>
				<td bgcolor="#EAEAEA" class="style21">
				<div align="center"><select name="TypeofCard">
					<option selected="selected" value=""></option>
					<option value="Visa">Visa</option>

					<option value="Mastercard">Mastercard</option>
				</select></div>
				</td>
				<td bgcolor="#EAEAEA" class="style21">
				<div align="center"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="NameonCard" type="text" id="NameonCard" size="30" /> </FONT></div>
				</td>
				<td bgcolor="#EAEAEA" class="style21">
				<div align="center"><FONT
					face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <input
					name="CardNumber" type="text" id="CardNumber" size="30" /> </FONT></div>
				</td>
				<td bgcolor="#EAEAEA" class="style21">
				<div align="center"><select name="CCExpiryMM" id="CCExpiryMM">
					<option selected="selected" value=""></option>
					<option value="01">Jan</option>
					<option value="02">Feb</option>
					<option value="03">Mar</option>

					<option value="04">Apr</option>
					<option value="05">May</option>
					<option value="06">Jun</option>
					<option value="07">Jul</option>
					<option value="08">Aug</option>
					<option value="09">Sep</option>

					<option value="10">Oct</option>
					<option value="11">Nov</option>
					<option value="12">Dec</option>
				</select> <select name="CCExpiryYYYY" id="CCExpiryYYYY">
					<option selected="selected" value=""></option>
					<option value="2009">2009</option>

					<option value="2010">2010</option>
					<option value="2011">2011</option>
					<option value="2012">2012</option>
					<option value="2013">2013</option>
					<option value="2014">2014</option>
					<option value="2015">2015</option>

					<option value="2016">2016</option>
					<option value="2017">2017</option>
					<option value="2018">2018</option>
					<option value="2019">2019</option>
					<option value="2020">2020</option>
				</select></div>
				</td>
			</tr>
			<tr>
				<td colspan="4" bgcolor="#f4f7e7">
				<p class="style21">For more information please phone <span
					class="style18"><strong>(416) 200-7728</strong></span></p>
				<p class="style21"><strong>I assume full responsibility
				for payment</strong>. I have read and acknowledged the <a
					href="http://www.prepskills.com/main/fees-policies" target="_blank">PREPSKILLS
				INC. policy including prepayment, no refunds or make up lessons</a> as
				outlined.</p>
				<p class="style21">I agree to the terms and conditions set forth
				by PREPSKILLS Inc.</p>
				<p class="style21">I recognize and accept that no reputable
				organization can make any guarantee as the development of skills or
				the results of future tests.</p>
				<p class="style21">I hereby release PREPSKILLS INC. or staff and
				the location from all claims, demands, losses, actions suits or
				proceeding rising out of the participation of the applicant named in
				any facility or at any location where the program/tutoring is being
				held.</p>
				<p class="style21"><strong><u>Your invoice will be
				issued to you via email upon submitting this online registration.</u></strong></p>
				</td>
			</tr>
			<tr>
				<td colspan="4" bgcolor="#94ce18" class="style5">
				<div align="center"><input type="submit" value="Submit"></div>
				</td>
			</tr>


		</table>
		</td>
	</tr>
</table>
</form>

</body>
</html>